So many ways to maintain an airway. Here are two video tutorials on intubating through a laryngeal mask. This one is a Laryngeal Mask from AMBU which AMBU calls a SGA (Supraglottic Airway), this particular SGA is called an AuraGain.
So many ways to maintain an airway. Here are two video tutorials on intubating through a laryngeal mask. This one is a Laryngeal Mask from AMBU which AMBU calls a SGA (Supraglottic Airway), this particular SGA is called an AuraGain.
This article was published in AUGUST 2012 by ©2012 ECRI Institute PSO
This is an interesting article which supports concerns I have raised over the past few years. It seems that their is little interest in Pressure Ulcer Prevention in the Respiratory Community. As this article points out it is an issue that should be addressed and I expect it will be, just not in a time frame I would likely set.
“Pressure ulcers found on the head or neck are typically associated with devices, while non-device-related pressure ulcers are generally found else-where (e.g., coccyx, buttocks) (Apold and Rydrych). Th e National Pressure Ulcer Advisory Panel (NPUAP) has stated that mucous membranes are “especially vulnerable to pressure from medical devices, ” including oxygen tubing, endotracheal tubes, and bite blocks (NPUAP).”
I suspect much of the reason could be due to some ambiguity as to who’s responsibility these fall under as they are “Respiratory Products” so nursing leaves them alone whole wound prevention and treatment is typically a Nursing issue so Respiratory does not aggressively pursue this. Thus article alludes to some kind of scenario like this in the following statement.
“one study noted that many staff members were unsure of who to contact regarding an incorrectly fitting device or were unaware of what a correctly fitted device looks like (Apold and Rydrych).”
I think the most obvious issues I saw when working in acute care was due poorly fitting CPAP masks used in attempts to avoid intubating patients (a philosophy I still believe in). Unfortunately the facility would routinely purchase “cheap” masks which required too much tension to maintain a proper fit. I was always looking for douderm to prevent the tissue breakdown which would inevitably occur. I suspect a cost analysis would have shown the cheap masks were far more expensive in the long run. The next most common issue I probably noticed was skin breakdown around the mouth due to endotracheal tubes and less than ideal tube fixation devices. As for cannula I paid little attention unless a nurse or patient specifically expressed a concern. At that time the only option I knew was to pad the cannula with some kind of wrapping or padding, after that I left it to nursing. Today there are much better options I have discussed in other posts but despite more and more literature coming out this does not seem to gain much traction. It is a mystery to me why there seems to be such apathy towards this in the Respiratory Community. Until this changes I will continue to address the subject, write posts and talk to those who will listen.
Medical Devices Pressure Ulcers
Declaration: I sell products that address these issues such as the WestMed soft cannula, Tracoe Tracheostomy Products, IPI ETT Fixation Devices, and B&B Tracheostomy products.
This is a review article of the GlideScope. “A long-term review by Canadian researchers has found that the GlideScope video laryngoscope delivers successful intubation in well over 90% of patients, and in 100% of cases when it is used as a rescue device.” This review study was done by the Dalhousie University in Halifax.
“The study period covered 76,454 general anesthetics, in which clinicians used the GlideScope in 1380 adults 1,005 as primary device (73%), 110 as a rescue device (8%) and 265 for elective teaching purposes ( 19%).”
The authors made a few points of interest.
1) There is a learning curve to using GlideScope
2) Largest reason is not inability to visualize cords but rather to pass ETT through the cords.
3) The GlideScope is the best known, most studied video laryngoscope on the market.
a) “The GlideScope is the best-known and most well-studied video laryngoscope,” said Dr. Doyle, a member of the editorial board of Anesthesiology News, “Ten years of clinical experience have shown that it deserves a special place in our airway toolbox, now taking an honourable place beside the Fiber-optic broochoscope as a major innovation in clinical airway management.”
4) One should use caition when considering some of the many new video laryngoscopes presently being introduced in the market.
a ) “Dr. Milne noted. “Many of the new airway devices hit the market without much scrutiny or Substantial evidence as to there validity and utility, particularly in the face of difficult airways and emergency situations.”
Declaration: I sell the GlideScope and I believe it is the best product on the market for an all around video laryngoscope. Of note I have had at least one of my competitors tell me that he shares my opinion.
This is a Poster study done in the UK by the Leeds Teaching Hospitals on a German Tracheostomy Percutaneous Dilation Trach (PDT) product from a company called Tracoe. I believe (but am not 100% certain) this study was published in 2007.
Link to Leeds Teaching Hospitals – http://www.leedsth.nhs.uk/home/
Essentially this system involves using a dilator introducer that is similar to the Blue Rhino by Cook Medical. The exceptional difference is the use of a collapsible silicone sleeve which folds back to remove lip after it is inserted in Trach tube. After the Trach tube is inserted into patient the inserter is removed.
The benefits are two fold here.
First the trach tube is easier to insert.
Second is that this is less traumatic for patient with a decreased risk of the tracheostomy tube catching on laryngeal ring, tissue, etc. requiring increased force to insert and then suddenly breaking free being inserted too far and too quickly striking the posterior wall of the larynx causing trauma (potential major complications).
At present my understanding is that risk factors for complications from tracheotomies are about the same for surgical and percutaneous trachs and a large reason for this is due to the difficulty caused by this lip between the introducer and the trach. Therefore it stands to reason that if this works like it is supposed to there could be a much lower risk of complications with percutaneous trachs.
As a therapist I have preferred percutaneous trachs because I have been under the impression there were fewer incidents of complications in addition to being much cleaner, healing faster, and being easier to care for.
In this study they evaluated the Tracoe Experc inserter with physicians giving it a subjective score for difficulty/ease of insertion with a range of (1) extremely difficult to (10) very easy. The median score was (9) with a range of scores from (7-10). So a very favorable opinion.
In this study a total of 51 patients were trached with the procedure taking from two to ten minutes (average of 5.27 minutes). 49 were successful on first attempt, two required a second dilation before successful placement of the Trach tube. There were no serious
complications with blood loss estimated at 3 to 5 mls, except for one who required a ligation of a venous bleed.
Dropbox Link to Video of Tracoe Experc Insertion
Another study entitled “Comparing the immediate complication rates of percutaneous dilatational tracheostomy on a tertiary referral surgical intensive care unit: Ciaglia Blue RhinoTM versus Tracoe experc®” was done in the UK in 2008 at the Freeman Hospitals in Newcastle. This study was done to assess and compare complication rates between blue rhino PDT and Tracoe Experc. A summary of that study is as follows.
The Tracoe® PDT is as safe as the Ciaglia Blue RhinoTM PDT, with complication rates in our hands below published audits, and we subjectively find it easier to insert.
• Additionally we appear to have a less cautious approach to PDT in coagulopathic patients without any increase in bleeding complications, which suggests our guidelines in such patients require review given our change in practice and the evolving evidence base.(5)
• It is crucial that we continue to audit our clinical practice, especially if tracheostomy is proved to be better earlier than current practice following “Tracman” trial.
Link to Freeman Hospitals in Newcastle – http://www.newcastle-hospitals.org.uk/index.aspx
My Declaration: I sell Tracoe products and stand to make financial gain if this is adopted in my sales territory. However (to the best of my knowledge) the writers of this article do not and I would not focus on this if I did not believe in it.
PERCUTANEOUS TRACHEOSTOMY IS EASIER WITH TRACOE EXPERC (Berlin ESIC 10_07)
Quotes I Liked:
The lip between the loading dilator and the tracheostomy tube tip often causes an obstruction to tracheostomy tube passage through the stoma in the anterior tracheal wall (Fig 1). This requires a greater degree of operator force for tube placement which can potentially cause damage to the posterior tracheal wall.
Posterior tracheal wall damage is a potentially fatal complication of PDT2. It remains uncertain as to whether using a single or serial dilatation technique carries a higher risk of this complication. The gap between the tracheostomy tube tip and loading dilator has been considered to be another important risk factor.
patients who require tracheostomy in the intensive care unit frequently have other signifi cant co-morbidities which can render surgical intervention high risk or prohibitive. The other alternative is to insert a stent, using rigid bronchoscopy, into the trachea to seal the defect.
This case series suggests that the Experc Tracheostomy Set allows for a single step dilation of the tracheal stoma with easier tracheostomy tube placement when compared to operator’s experiences with other commercially available kits.
A randomised controlled trial is warranted to assess its advantages over the other singe dilator kits.
Come Unto Christ
the AnaConDa technology people
Life is simple. All you have to do is breathe.
from the frontlines of critical care
Life is simple. All you have to do is breathe.
Life is simple. All you have to do is breathe.
Life is simple. All you have to do is breathe.
Life is simple. All you have to do is breathe.
Life is simple. All you have to do is breathe.
Life is simple. All you have to do is breathe.
Life is simple. All you have to do is breathe.
Life is simple. All you have to do is breathe.
Life is simple. All you have to do is breathe.
Life is simple. All you have to do is breathe.
Life is simple. All you have to do is breathe.
Life is simple. All you have to do is breathe.
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